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Nguyen TK, Nguyen HH, Nguyen CL, Luong TH, Dinh LD, Le VD, Dang KK, Tran TL. Case report: Candidiasis of gastrojejunostomosis after pancreaticoduodenectomy: Preliminary experience from two cases. Front Oncol 2022; 12:888927. [PMID: 36091142 PMCID: PMC9449841 DOI: 10.3389/fonc.2022.888927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 08/02/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction Invasive Candida infection, or candidiasis, especially in gastrointestinal tract (GIT) is an infrequent but aggressive disease caused by Candida species. Candidiasis of gastrojejunostomosis after extensive gastrointestinal surgery may cause serious complications such as perforative peritonitis and anastomotic stenosis, which requires surgical interventions. Case presentation Our two patients had undergone pancreaticoduodenectomy (PD), respectively, due to pancreatic ductal adenocarcinoma and intraductal papillary mucinous neoplasms of the pancreatic head. Both the patients were malnutritioned and debilitated before the surgery, and they required reoperation for postoperative Candidiasis-relevant complication.In the first case, the patient was readmitted to the hospital with symptoms of perforative peritonitis, for which he underwent surgery and had Candida found in both gastrojejunostomosis ulcer and peritoneal fluid. In our second case, the patient was admitted to the hospital twice after the first operation and diagnosed with Candida-induced gastrojejunostomosis stenosis by esophagogastroduodenoscopy (EGD) and endoscopic biopsy. Fluconazole was indicated for a 2-week regimen. Blood sample withdrawn afterward showed no evidence of fungal agents, and the anastomotic stenosis responded well to treatment. However, after 3 weeks, he came back with cachexia and symptoms of gastrojejunostomotic stenosis. EGD showed no image of fungal agents but anastomotic stenosis due to chronic inflammatory process. The patient was then reoperated to redo his gastrojejunostomosis. Conclusion Candidiasis of gastrojejunostomosis after extensive gastrointestinal surgery such as PD is a very aggressive condition that may cause perforative peritonitis and anastomotic stenosis. However, there have been no publications on this disorder, and the strategic treatment remains unknown. We hereby present a report of two cases with postoperative gastrojejunostomosis candidiasis presenting with non-specific but aggressive and early clinical symptoms.
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Affiliation(s)
- Thanh Khiem Nguyen
- Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Bach Mai Hospital, Hanoi, Vietnam
| | - Ham Hoi Nguyen
- Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Bach Mai Hospital, Hanoi, Vietnam
| | - Cong Long Nguyen
- Department of Gastroenterology and Hepatology, Bach Mai Hospital, Hanoi, Vietnam
- University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Tuan Hiep Luong
- Department of Surgery, Hanoi Medical University, Hanoi, Vietnam
- *Correspondence: Tuan Hiep Luong,
| | - Long Doan Dinh
- University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Van Duy Le
- Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Bach Mai Hospital, Hanoi, Vietnam
| | - Kim Khue Dang
- Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Bach Mai Hospital, Hanoi, Vietnam
| | - Thi Lan Tran
- Pathology Center, Bach Mai Hospital, Hanoi, Vietnam
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Saracino IM, Foschi C, Pavoni M, Spigarelli R, Valerii MC, Spisni E. Antifungal Activity of Natural Compounds vs. Candida spp.: A Mixture of Cinnamaldehyde and Eugenol Shows Promising In Vitro Results. Antibiotics (Basel) 2022; 11:73. [PMID: 35052950 PMCID: PMC8773119 DOI: 10.3390/antibiotics11010073] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/30/2021] [Accepted: 01/05/2022] [Indexed: 01/09/2023] Open
Abstract
Candida spp. are commensal organisms of the skin, mucous membranes, gastrointestinal tract, blood, and vagina of animals and humans. In recent decades, the incidence of human fungal infections has increased, with Candida spp. (mainly C. albicans) infections being the most frequent, and the treatment of fungal infections is still a clinical challenge. Colonization of the human gastrointestinal tract by Candida spp. is significant because infections (e.g., candidemia and vulvovaginal candidiasis) frequently arise from commensal microorganisms. The aim of this study was to test in vitro the antifungal activity and the eventual synergistic effect of five pure components of essential oils: cinnamaldehyde, α-pinene, limonene, eucalyptol, and eugenol. These compounds were tested on 18 Candida strains (15 C. albicans, 2 C. glabrata, and 1 C. lusitaniae) derived from a culture collection of vaginal clinical strains. METHODS Fungistatic activity was evaluated using the disk diffusion method. For fungicidal activity, microdilution and time-kill curve protocols were set up. The checkerboard method was chosen to evaluate a possible synergistic effect of these compounds when mixed. RESULTS Cinnamaldehyde and eugenol gave the best results, inhibiting all the Candida strains and showing a highly additive effect (FICI 0.625). The cinnamaldehyde inhibition zone (IZ), MIC, and MFC means were 69 mm, 50.05 mg/L, and 109.26 mg/L respectively. Cinnamaldehyde led to the total loss of viable Candida cells within 4 h. Eugenol IZ, MIC, and MFC means were 35.2 mm, 455.42 mg/L, and 690.09 mg/L, respectively. Eugenol led to the total loss of viable fungal cells within 1 h. Treatment with α-pinene inhibited 88.9% of Candida strains, with an IZ mean of 21.2 mm, a MIC mean of 195.41 mg/L, and a MFC mean of 251.27 mg/L; this compound led to the total loss of viable fungal cells only after 24 h. Limonene inhibited only 33.3% of the tested strains and eucalyptol did not produce an inhibition halo, so these compounds were not tested further. CONCLUSIONS These characteristics, together with the well-known safety of cinnamaldehyde and eugenol for human use, make these two natural compounds the perfect candidates for the treatment of candidiasis. This was a pilot study, the purpose of which was to evaluate the best composition of a mixture to be used against intestinal and vulvovaginal candidiasis; in vivo studies are needed to confirm these very encouraging results.
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Affiliation(s)
- Ilaria Maria Saracino
- Microbiology Unit, Department of Specialized, Experimental and Diagnostic Medicine, Istituto di Ricovero e Cura a Carattere Scientifico St. Orsola Polyclinic, University of Bologna, 40138 Bologna, Italy; (C.F.); (M.P.)
| | - Claudio Foschi
- Microbiology Unit, Department of Specialized, Experimental and Diagnostic Medicine, Istituto di Ricovero e Cura a Carattere Scientifico St. Orsola Polyclinic, University of Bologna, 40138 Bologna, Italy; (C.F.); (M.P.)
| | - Matteo Pavoni
- Microbiology Unit, Department of Specialized, Experimental and Diagnostic Medicine, Istituto di Ricovero e Cura a Carattere Scientifico St. Orsola Polyclinic, University of Bologna, 40138 Bologna, Italy; (C.F.); (M.P.)
| | - Renato Spigarelli
- Department of Biological, Geological and Environmental Sciences, University of Bologna, 40126 Bologna, Italy; (R.S.); (M.C.V.); (E.S.)
| | - Maria Chiara Valerii
- Department of Biological, Geological and Environmental Sciences, University of Bologna, 40126 Bologna, Italy; (R.S.); (M.C.V.); (E.S.)
| | - Enzo Spisni
- Department of Biological, Geological and Environmental Sciences, University of Bologna, 40126 Bologna, Italy; (R.S.); (M.C.V.); (E.S.)
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The Phylogeny and Biological Function of Gastric Juice-Microbiological Consequences of Removing Gastric Acid. Int J Mol Sci 2019; 20:ijms20236031. [PMID: 31795477 PMCID: PMC6928904 DOI: 10.3390/ijms20236031] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 11/24/2019] [Accepted: 11/25/2019] [Indexed: 12/15/2022] Open
Abstract
Gastric juice is a unique combination of hydrochloric acid (HCl), lipase, and pepsin. Acidic gastric juice is found in all vertebrates, and its main function is to inactivate microorganisms. The phylogenetic preservation of this energy-consuming and, at times, hazardous function (acid-related diseases) reflects its biological importance. Proton pump inhibitors (PPIs) are one of the most widely used drugs in the world. Due to the reduced prevalence of Helicobacter pylori infection as well as the increased use of inhibitors of gastric acid secretion, the latter has become the most important cause of gastric hypoacidity. In the present manuscript, we review the microbiological consequences of removing gastric acidity. The resulting susceptibility to infections has not been studied extensively, and focus has mainly been restricted to bacterial and parasitic agents only. The strongest evidence concerning the relationship between hypochlorhydria and predisposition to infections relates to bacterial infections affecting the gastrointestinal tract. However, several other clinical settings with increased susceptibility to infections due to inhibited gastric acidity are discussed. We also discuss the impact of hypochlorhydria on the gut microbiome.
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Abstract
This manuscript presents a review of infectious causes of gastritis aimed at the practicing anatomic pathologist. We shall highlight unique histologic findings and clinical attributes that will assist those analyzing endoscopically obtained mucosal biopsies of the stomach or resection specimens.
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Abstract
This narrative review summarises the benefits, risks and appropriate use of acid-suppressing drugs (ASDs), proton pump inhibitors and histamine-2 receptor antagonists, advocating a rationale balanced and individualised approach aimed to minimise any serious adverse consequences. It focuses on current controversies on the potential of ASDs to contribute to infections-bacterial, parasitic, fungal, protozoan and viral, particularly in the elderly, comprehensively and critically discusses the growing body of observational literature linking ASD use to a variety of enteric, respiratory, skin and systemic infectious diseases and complications (Clostridium difficile diarrhoea, pneumonia, spontaneous bacterial peritonitis, septicaemia and other). The proposed pathogenic mechanisms of ASD-associated infections (related and unrelated to the inhibition of gastric acid secretion, alterations of the gut microbiome and immunity), and drug-drug interactions are also described. Both probiotics use and correcting vitamin D status may have a significant protective effect decreasing the incidence of ASD-associated infections, especially in the elderly. Despite the limitations of the existing data, the importance of individualised therapy and caution in long-term ASD use considering the balance of benefits and potential harms, factors that may predispose to and actions that may prevent/attenuate adverse effects is evident. A six-step practical algorithm for ASD therapy based on the best available evidence is presented.
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Justo Alonso I, Sanabria Mateos R, Marcacuzco Quinto A, Caso Maestro Ó, Cambra Molero F, Calvo Pulido J, Manrique A, Jiménez Romero C. Candidiasis intraabdominal masiva secundaria a cirugías digestivas en pacientes inmunocompetentes. A propósito de 2 casos. INFECTIO 2016. [DOI: 10.1016/j.infect.2015.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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8
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Massarrat S, Saniee P, Siavoshi F, Mokhtari R, Mansour-Ghanaei F, Khalili-Samani S. The Effect of Helicobacter pylori Infection, Aging, and Consumption of Proton Pump Inhibitor on Fungal Colonization in the Stomach of Dyspeptic Patients. Front Microbiol 2016; 7:801. [PMID: 27252698 PMCID: PMC4879133 DOI: 10.3389/fmicb.2016.00801] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 05/11/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The importance of coinfection of Helicobacter pylori (H.pylori) and Candida albicans (C. albicans) in the development of gastric diseases is not known. In this study, the frequency of concurrent infection of H. pylori and C. albicans in dyspeptic patients was assessed while considering age, gender, and PPI consumption of patients. METHODS Gastric biopsies were taken from 74 yeast-positive dyspeptic patients and gastric disease, age, gender, and proton pump inhibitor (PPI) consumption of subjects were recorded. One antral biopsy was used for rapid urease test (RUT) and one for H. pylori and yeast cultivation and smear preparation. Bacterial isolates were identified according to spiral morphology and the biochemical characteristics. Yeast isolates were identified on Chromagar and by the Nested-PCR amplification of C. albicans-specific topoisomerase II gene. Twenty-seven biopsy smears were Gram-stained and examined by the light microscope for observing H. pylori and yeast cells. RESULTS Fifty-four (73%) of patients were >40 year. Of 68 patients with PPI consumption record, 46 (67.6%) consumed PPI (p = 0). Comparison of patients in peptic ulcer group (12, 16.2%) with (6, 8.1%) or without (6, 8.1%) H. pylori or in gastritis group (62, 83.8%) with (25, 33.8%) or without (37, 50%) H. pylori showed no significant difference (p > 0.05). Of the 46 patients who consumed PPI, 13 (17.5%) were H. pylori-positive and 33 (44.6%) H. pylori-negative (p = 0). Ten out of twenty-seven smears showed the occurrence of H. pylori cells, including three with yeast cells. Of the 17 H. pylori-negative smears, three showed the occurrence of yeast cells only. Yeasts stained Gram-positive or Gram-negative and appeared as single or budding cells. CONCLUSION The older age and PPI consumption could favor fungal colonization in the human stomach. The occurrence of a considerable number of H. pylori-positive or H. pylori-negative patients with gastritis or peptic ulcer shows that co-infection of Candida and H. pylori or infection of yeast alone could be associated with dyspeptic diseases. The occurrence of yeast cells in gastric biopsies with different Gram's reactions indicates that fungi might change their cell wall components for establishing a persistent colonization in the stomach.
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Affiliation(s)
- Sadegh Massarrat
- Endoscopy Department, Digestive Disease Research Institute, Tehran University of Medical Sciences Tehran, Iran
| | - Parastoo Saniee
- Department of Microbiology, School of Biology, University College of Sciences, University of Tehran Tehran, Iran
| | - Farideh Siavoshi
- Department of Microbiology, School of Biology, University College of Sciences, University of Tehran Tehran, Iran
| | - Reyhane Mokhtari
- Department of Microbiology, School of Biology, University College of Sciences, University of Tehran Tehran, Iran
| | - Fariborz Mansour-Ghanaei
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences Rasht, Iran
| | - Saman Khalili-Samani
- Department of Microbiology, School of Biology, University College of Sciences, University of Tehran Tehran, Iran
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Question of an infectious etiology or contribution to the pathogenesis of infantile hypertrophic pyloric stenosis. J Pediatr Gastroenterol Nutr 2014; 58:546-8. [PMID: 24345839 DOI: 10.1097/mpg.0000000000000261] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Infantile hypertrophic pyloric stenosis is a concerning cause of nonbilious vomiting in the neonatal population. Although a number of etiological theories exist, its exact cause remains nebulous. The question of an infectious etiology (or contribution) has been previously examined in case reports and case series, with recent support through suggestions of seasonality and familial aggregation with unclear inheritance patterns. The present review discusses the published literature regarding infectious etiologies of infantile hypertrophic pyloric stenosis. Furthermore, it attempts to demonstrate that newer research regarding an NOS1 genetic etiology does not exclude, but rather can be consistent with, an infectious etiology.
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Moon RC, Teixeira AF, Goldbach M, Jawad MA. Management and treatment outcomes of marginal ulcers after Roux-en-Y gastric bypass at a single high volume bariatric center. Surg Obes Relat Dis 2014; 10:229-34. [DOI: 10.1016/j.soard.2013.10.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 09/16/2013] [Accepted: 10/01/2013] [Indexed: 01/28/2023]
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Hayama K, Ishijima S, Ono Y, Izumo T, Ida M, Shibata H, Abe S. Protective Activity of S-PT84, a Heat-killed Preparation of Lactobacillus pentosus, against Oral and Gastric Candidiasis in an Experimental Murine Model. Med Mycol J 2014; 55:J123-9. [DOI: 10.3314/mmj.55.j123] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Pirrone A, Castagnetti C, Mariella J, Bonoli C, Stancampiano L, Tampieri MP, Galuppi R. Yeast Flora in Oropharyngeal and Rectal Mucous Membranes of Healthy and Critically Ill Neonatal Foals. J Equine Vet Sci 2012. [DOI: 10.1016/j.jevs.2011.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kumamoto CA. Inflammation and gastrointestinal Candida colonization. Curr Opin Microbiol 2011; 14:386-91. [PMID: 21802979 DOI: 10.1016/j.mib.2011.07.015] [Citation(s) in RCA: 163] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 07/06/2011] [Indexed: 02/06/2023]
Abstract
Candida organisms commonly colonize the human gastrointestinal tract as a component of the resident microbiota. Their presence is generally benign. Recent studies, however, show that high level Candida colonization is associated with several diseases of the gastrointestinal tract. Further, results from animal models argue that Candida colonization delays healing of inflammatory lesions and that inflammation promotes colonization. These effects may create a vicious cycle in which low-level inflammation promotes fungal colonization and fungal colonization promotes further inflammation. Both inflammatory bowel disease and gastrointestinal Candida colonization are associated with elevated levels of the pro-inflammatory cytokine IL-17. Therefore, effects on IL-17 levels may underlie the ability of Candida colonization to enhance inflammation. Because Candida is a frequent colonizer, these effects have the potential to impact many people.
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Affiliation(s)
- Carol A Kumamoto
- Department of Molecular Biology and Microbiology, Tufts University, 136 Harrison Ave., Boston, MA 02111, USA.
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Joo MK, Park JJ, Lee BJ, Kim JH, Yeon JE, Kim JS, Byun KS, Bak YT. A case of stenotic change from gastric candidiasis managed with temporary stent insertion. Gut Liver 2011; 5:238-41. [PMID: 21814608 PMCID: PMC3140673 DOI: 10.5009/gnl.2011.5.2.238] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Accepted: 04/27/2010] [Indexed: 11/26/2022] Open
Abstract
Invasive gastric Candida infection in patient with co-morbidity can cause stenotic change if it is developed at anatomically narrowing portion, such as distal antrum, pylorus, or duodenal bulb. However, proper management of benign stenosis by diffuse gastric Candidasis is still under controversy and palliative bypass surgery has several shortcomings because high risk operative group may be included in this case. Palliative placement of self-expandable metallic stent has been settled as a standard management of malignant gastric pyloric obstruction and it is expected to be applied in benign stenotic lesions due to its gradual dilation effect. We described a case of stenosis by diffuse gastric Candidasis at anastomosis of subtotal gastrectomy, which was managed by temporary placement of self-expandable metallic stent.
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Affiliation(s)
- Moon Kyung Joo
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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Bollo J, Carrilo E, Lupu I, Caballero F, Trias M. [Gastric perforation associated with Candida infection]. GASTROENTEROLOGIA Y HEPATOLOGIA 2009; 32:499-501. [PMID: 19577337 DOI: 10.1016/j.gastrohep.2009.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Revised: 03/09/2009] [Accepted: 03/19/2009] [Indexed: 11/25/2022]
Abstract
Notable causes of gastroduodenal ulcer are Helicobacter pylori infection, intake of non-steroidal anti-inflammatory agents, neoplastic disease, acid hypersecretory states and secondary peptic ulcer disease. There are case reports of healthy patients or those with risk factors for fungal infection who develop gastroduodenal ulcer perforation associated with the presence of fungi in ascitic fluid or gastroduodenal ulcer tissue but without the above-mentioned etiological factors. Thus, other factors and pathogens may be involved in the pathogenesis of perforation. The use of antifungal agents in patients following surgery for a perforated gastroduodenal ulcer is controversial. We report two cases of healthy patients who underwent surgery for perforated gastroduodenal ulcer, in whom the most frequent causes of perforation were excluded. Only the presence of Candida in the ulcer was found.
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Affiliation(s)
- Jesús Bollo
- Servicio de Cirugía General y Digestiva, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España.
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Brian Smith P, Steinbach WJ, Benjamin DK. Invasive Candida infections in the neonate. Drug Resist Updat 2005; 8:147-62. [PMID: 16002326 DOI: 10.1016/j.drup.2005.04.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2005] [Revised: 04/27/2005] [Accepted: 04/28/2005] [Indexed: 11/16/2022]
Abstract
Advances in medical therapy have increased premature infant survival. A rise in Candida infections in neonatal intensive care units (NICUs) has followed. Once considered a contaminant, Candida is now recognized as a major cause of mortality and morbidity within these units. We will examine what is known about the epidemiology, risk factors and end-organ involvement of Candida infections with a focus on invasive disease. In addition, diagnostic alternatives to traditional blood culture, experience with antifungal agents for prophylaxis and therapeutic options, including newer antifungal agents, will be presented.
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Affiliation(s)
- P Brian Smith
- Department of Pediatrics, Duke University, PO Box 17969, Durham, NC 27705, USA
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Abstract
All vertebrates produce gastric acid. Its main function is inactivation of ingested microorganisms. The majority of microbiological pathogens ingested never reaches the intestine because of the gastric barrier. Although gastric hypochlorhydria is fairly common due to atrophic gastritis, gastric surgery or use of inhibitors of gastric acid secretion, the resulting susceptibility to infection has not been studied extensively. Drug-induced blockade of acid secretion leads to gastrointestinal bacterial overgrowth; the clinical significance of this is still controversial. Gastric acidity is known to protect against non-typhoid salmonellosis and cholera and it is suspected that it protects against several parasitic diseases as giardiasis and strongyloides. There is a lack of studies focusing on the impact of the gastric acidic barrier on viral infections. Concerning prion infections only a single study has been performed, demonstrating a possible role of gastric acidity in the protection against foodborne prion disease in mice. The combination of malnutrition and hypochlorhydria may contribute to the high prevalence of gastrointestinal infections in developing countries. Further studies are needed to evaluate the clinical consequences of impaired gastric acidity with respect to susceptibility to infections.
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Affiliation(s)
- Tom C Martinsen
- Department of Cancer Research and Molecular Medicine, Children's and Women's Health, Norwegian University of Science and Technology and University Hospital of Trondheim, Norway.
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de Bruijn CM, Wijnberg ID. Potential role of candida species in antibiotic-associated diarrhoea in a foal. Vet Rec 2004; 155:26-8. [PMID: 15264488 DOI: 10.1136/vr.155.1.26] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- C M de Bruijn
- Department of Equine Sciences, PO Box 80153, 3508 TD, Utrecht University, The Netherlands
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Monteagudo C, Viudes A, Lazzell A, Martinez JP, Lopez-Ribot JL. Tissue invasiveness and non-acidic pH in human candidiasis correlate with "in vivo" expression by Candida albicans of the carbohydrate epitope recognised by new monoclonal antibody 1H4. J Clin Pathol 2004; 57:598-603. [PMID: 15166263 PMCID: PMC1770313 DOI: 10.1136/jcp.2003.013177] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The morphogenetic conversion between yeast and hyphal growth forms appears to be crucial in the pathogenesis of invasive candidiasis, and can be regulated by environmental signals such as extracellular pH. AIMS To characterise the epitope recognised by monoclonal antibody 1H4, and to evaluate the expression of its corresponding epitope in Candida albicans cells under different conditions of pH and temperature, and "in vivo", in tissue samples from patients with human candidiasis. METHODS Monoclonal antibody 1H4 was generated against the 58 kDa cell wall mannoprotein of C albicans (mp58), and was further characterised by immunoblot analysis, periodate treatment of the antigenic preparations, and agglutination experiments of C albicans strains 3153A, SC5314, and 412, cultured under different environmental conditions (growth media and pH). An immunohistochemical study was performed in 24 human tissue samples from patients with mucocutaneous and systemic candidiasis. RESULTS 1H4 recognises a pH sensitive carbohydrate epitope on the surface of C albicans cells, and this epitope is not restricted to mp58, but is shared with other cell wall mannoproteins. Immunohistochemical findings indicated that expression of the 1H4 epitope on C albicans cells in tissue sections from human candidiasis correlates with tissue invasion and pH of the niche. 1H4 immunoreactivity was also found in candida remnants within macrophages. CONCLUSIONS The fact that 1H4 epitope expression selectively identifies invasive forms of C albicans, in addition to candida remnants within macrophages, supports its potential value in the diagnosis and management of human candidiasis.
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Affiliation(s)
- C Monteagudo
- Department of Pathology University of Valencia, 46010 - Valencia, Spain.
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Sari R, Altunbas H, Mahsereci E, Meric M, Gelen T, Karayalcin U. Multiple gastric ulcers caused by gastric candidiasis in a diabetic patient: a rare cause of upper GI bleeding. Gastrointest Endosc 2003; 58:309-11. [PMID: 12872114 DOI: 10.1067/mge.2003.330] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Ramazan Sari
- Department of Internal Medicine, Division of Endocrinology, Akdeniz University, School of Medicine, Antalya, Turkey
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Khatib R, Ramanathan J, Riederer KM, DePoister D, Baran J. Limited genetic diversity of Candida albicans in fecal flora of healthy volunteers and inpatients: a proposed basis for strain homogeneity in clinical isolates. Mycoses 2002; 45:393-8. [PMID: 12421288 DOI: 10.1046/j.1439-0507.2002.00774.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Molecular analysis of Candida albicans isolates from individual patients often yields a single strain at multiple sites. Whether this strain-limitation is due to virulence factors favoring the invasive strain or to lack of genetic diversity in the gastrointestinal reservoir is uncertain. We elected to study C. albicans genotypes in the fecal flora among healthy volunteers and inpatients. Self-obtained stool swabs or stool samples were cultured on inhibitory mold agar. From each subject with C. albicans, nine colonies were randomly selected, individually propagated, and typed utilizing random amplified polymorphic DNA. Colonies were considered identical (all bands matched), related variants (one to three unique bands), or distinct strains (more than three unique bands). Analysis showed a single clone in 33/43 (76.7%) volunteers and 6/18 (33.3%) inpatients (P = 0.018), two to four related variants in eight (18.6%) volunteers and 10 (55.6%) inpatients, and two distinct strains in two volunteers (4.6%) and two inpatients (11.1%). Strain variation was more common in females (33.5 versus 5.6%; P = 0.04) and tended to increase with age (r = 0.245, P = 0.06). These findings illustrate that most healthy subjects harbor a single strain of C. albicans in the fecal flora. This strain may undergo genetic evolution leading to minor clonal variations. The mechanisms for strain selection, maintenance and possible evolution remain to be delineated.
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Affiliation(s)
- R Khatib
- St John Hospital and Medical Center, Detroit, MI 48236,USA.
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Krone CA, Elmer GW, Ely JT, Fudenberg HH, Thoreson J. Does gastrointestinal Candida albicans prevent ubiquinone absorption? Med Hypotheses 2001; 57:570-2. [PMID: 11735312 DOI: 10.1054/mehy.2001.1410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Ubiquinones (coenzyme Qs (CoQ)) are essential for oxidative phosphorylation in yeasts and humans, although the isomers present in each are different. The human coenzyme Q, CoQ10, is administered orally for the treatment of heart disease and other disorders. Some patients, however, require much higher doses than others to attain a therapeutic CoQ10 blood level. We propose that one possible explanation for this variability is Candida colonization of the GI tract. Many common medical treatments including antibiotics and anti-hyperchlorhydric agents increase the risk of GI tract Candida colonization. Subsequent uptake and utilization of supplemental CoQ10 by the yeast could diminish availability for the human subject. Data from one patient and an in vitro pilot study using two pathogenic strains of C. albicans support this hypothesis. If C. albicans in the GI tract can hinder availability and interfere with therapeutic effects of CoQ10, it could be of clinical significance for large numbers of patients.
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Affiliation(s)
- C A Krone
- Applied Research Institute, PO Box 1925, Palmerston North, New Zealand.
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Agastya G, West BC, Callahan JM. Omeprazole inhibits phagocytosis and acidification of phagolysosomes of normal human neutrophils in vitro. Immunopharmacol Immunotoxicol 2000; 22:357-72. [PMID: 10952036 DOI: 10.3109/08923970009016425] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We postulated omeprazole inhibition of the neutrophil proton pump, impairing phagocytosis and phagolysosomal acidification. Neutrophils from healthy human beings were treated with omeprazole prodrug 0.5 mM/l or acid activated omeprazole 0.5 mM/l, then incubated with killed Saccharomyces cerevisiae stained with bromcresol purple. Wet mounts were done at 10, 30 and 60 minutes. Percent neutrophils phagocytosing, percent yeast phagocytosed, and yeast per phagocytosing neutrophil were significantly decreased in acid activated omeprazole compared to controls and omeprazole prodrug. In contrast, percent acidification of intracellular yeast was significantly lower in both omeprazole prodrug and acid activated omeprazole compared to controls. Over time, control neutrophils showed an increase in percent yeast phagocytosed and yeast per phagocytosing neutrophil. When treated with acid activated omeprazole, the percent of neutrophils phagocytosing progressively decreased over time. We observed 1) omeprazole prodrug does not inhibit neutrophil phagocytosis but does inhibit phagolysosomal acidification, whereas 2) acid activated omeprazole inhibits both neutrophil phagocytosis and phagolysosome acidification. We conclude that omeprazole impairs these neutrophil functions in vitro.
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Affiliation(s)
- G Agastya
- The Department of Medicine Research Laboratory, Huron Hospital, East Cleveland, OH 44112, USA
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Richardson P, Hawkey CJ, Stack WA. Proton pump inhibitors. Pharmacology and rationale for use in gastrointestinal disorders. Drugs 1998; 56:307-35. [PMID: 9777309 DOI: 10.2165/00003495-199856030-00002] [Citation(s) in RCA: 182] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Proton pump inhibitors (PPIs) are drugs which irreversibly inhibit proton pump (H+/K+ ATPase) function and are the most potent gastric acid-suppressing agents in clinical use. There is now a substantial body of evidence showing improved efficacy of PPIs over the histamine H2 receptor antagonists and other drugs in acid-related disorders. Omeprazole 20 mg/day, lansoprazole 30 mg/day, pantoprazole 40 mg/day or rabeprazole 20 mg/day for 2 to 4 weeks are more effective than standard doses of H2-receptor antagonists in healing duodenal and gastric ulcers. Patients with gastric ulcers should receive standard doses of PPIs as for duodenal ulcers but for a longer time period (4 to 8 weeks). There is no conclusive evidence to support the use of a particular PPI over another for either duodenal or gastric ulcer healing. For Helicobacter pylori-positive duodenal ulceration, a combination of a PPI and 2 antibacterials will eradicate H. pylori in over 90% of cases and significantly reduce ulcer recurrence. Patients with H. pylori-positive gastric ulcers should be managed similarly. PPIs also have efficacy advantages over ranitidine and misoprostol and are better tolerated than misoprostol in patients taking nonsteroidal anti-inflammatory drugs (NSAIDs). In endoscopically proven gastro-oesophageal reflux disease, standard daily doses of the PPIs are more effective than H2-receptor antagonists for healing, and patients should receive a 4 to 8 week course of treatment. For severe reflux, with ulceration and/or stricture formation, a higher dose regimen (omeprazole 40 mg, lansoprazole 60 mg, pantoprazole 80 mg or rabeprazole 40 mg daily) appears to yield better healing rates. There is little evidence that PPIs lead to resolution of Barrett's oesophagus or a reduction of subsequent adenocarcinoma development, but PPIs are indicated in healing of any associated ulceration. In Zollinger-Ellison syndrome, PPIs have become the treatment of choice for the management of gastric acid hypersecretion.
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Affiliation(s)
- P Richardson
- Division of Gastroenterology, University Hospital, Queens Medical Centre, Nottingham, England
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